Acquired brain injury (“ABI”) includes without limitation stroke, chronic traumatic encephalopathy, spinal cord injury, and traumatic brain injury (“TBI”). Survivors of ABI or other individuals affected by any condition, disorder, or experience (collectively referred to as “survivors”), noted in this disclosure, often sustain impaired or eradicated use of one or more extremities and other body parts. The consequences include mild to severe disabilities to control physical movements or movement and actions. The disabilities exist despite, in many instances, the affected body parts being somewhat or totally physically uninjured.
For survivors, performing physical movements or movement and actions corresponding to purposeful physical movements or movement and actions they used to make is difficult or impossible. They need to self re-train/re-learn to perform movements or movement and actions before being able to move. Such self re-training/re-learning requires brain and nervous system motor control planning and command processes. However, survivors have chronic disconnections between intact and in many cases, initially uninjured body parts and non-functional or dysfunctional brain and nervous system planning and command processes required for purposeful movements of body parts. In some cases survivors' difficulties are magnified due to their being unaware that the affected body part still exists.
Conventional physical and occupational rehabilitation/therapies for treating ABIs are primarily physical in nature. They involve assisted efforts to restore survivors' abilities to make unaffected physical movement and actions. Physical and occupational therapy movement and actions are characterized by manipulations, i.e., movements of survivors' body parts, corresponding to unaffected movements. For example, when a survivor recovering from a stroke or TBI undergoes rehabilitation to regain proper axial movement of the survivor's arm at the shoulder, she/he with assistance repeatedly attempts to move (or have moved with professional or mechanical assistance) her/his arm in the axial direction. Those assisted movements are to promote recovery by assisted manipulation of extremities to make movements corresponding to movements survivors used to make without assistance. That process is predominantly control of the extremities from the outside-in.
In addition to survivors' physical and occupational rehabilitation/therapies, at least one of three other therapies is used, namely, motor imagery, mirror therapy, and movement and action-observation therapy. Motor imagery involves imagining motor controls and attempting to physically exercise the resulting imagery. Mirror therapy has been used for amputees experiencing phantom limb pain. It involves using an intact body part to make physical movement and actions reflected in a physical minor. The mirrored movement and actions appear to be made by the contralateral (amputated) body part. The patient's observation of said movement and actions has been shown to decrease or terminate phantom limb pain. Movement and action-observation therapy is theoretically mirror-neuron-based and involves viewing physical movement and actions followed by the patient's efforts to match or imitate the observed movement and actions.
Physical or occupational therapies are based on hands-on or assisted physical manipulation. They address planning to purposefully move by physically moving extremities (an outside-in process). The therapies discussed above are imagery (synonymously “visualization”) based, however imagined movements result in imagined feedback (an inside-in process).
ABI survivors' chronic disabilities require extensive rehabilitation. Survivors undergo long-term and costly physical and occupational therapies. These are major healthcare services and cost issues representing a major unmet medical need. Epidemiologically, and by way of example, the approximate number of annual survivors of ABI and spinal cord injury in the European Community (EC) is 4.4 million individuals and in the United States 2.75 million individuals. A broader category, neurotrauma (penetrating and non-penetrating), including primary brain tumor, focal dystonias, limb apraxia/ataxia, cerebral palsy and amputations, annually affects more than 19 million EC individuals, 12 million U.S. civilians and approximately 200,000-400,000 U.S. combat veterans.